Provider Demographics
NPI:1699054403
Name:DAVIS, MARGRETT R (CHES)
Entity type:Individual
Prefix:
First Name:MARGRETT
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W WOODROW WILSON DRIVE
Mailing Address - Street 2:SUITE107
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213
Mailing Address - Country:US
Mailing Address - Phone:601-982-8467
Mailing Address - Fax:601-982-8468
Practice Address - Street 1:350 W WOODROW WILSON AVE STE 107
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7682
Practice Address - Country:US
Practice Address - Phone:601-982-8467
Practice Address - Fax:601-982-8467
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR501662163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator